A 78-year-old woman with rheumatic heart disease and tissue aortic valve replacement 2 years previously presented to the cardiology clinic with worsening breathlessness and weight gain. She had New York Heart Association (NYHA) class III dyspnea. Neck examination revealed large, systolic, monomorphic pulsations (Figure A; Supplemental Video 1, available online at http://www.mayoclinicproceedings.org ). A grade 3/6 holosystolic murmur was heard, loudest at the left-lower sternal edge, which was augmented by inspiration.
A 78-year-old woman with rheumatic heart disease and tissue aortic valve replacement 2 years previously presented to the cardiology clinic with worsening breathlessness and weight gain. She had New York Heart Association (NYHA) class III dyspnea. Neck examination revealed large, systolic, monomorphic pulsations (Figure A; Supplemental Video 1, available online at http://www.mayoclinicproceedings.org ). A grade 3/6 holosystolic murmur was heard, loudest at the left-lower sternal edge, which was augmented by inspiration.